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CRC Client Registration

PERSONAL INFORMATION
Name*
First Last
Gender*
- Male
- Female
Date of Birth*
Address*
Street Address Suburb/Town State Post Code
Home Phone*
- I do not currently have an active home phone number
Mobile*
- I do not currently have an active mobile number
Email*
- I do not currently have an email address

BACKGROUND INFORMATION
Were you born in Australia?*
- Yes
- No
Where were you born?*
Do you identify as being of Aboriginal or Torres Strait Islander descent?*
- Yes
- No
Is English your main spoken language?*
- Yes
- No
What is your main spoke language?*
Do you have access to transport?*
- Yes
- No
Main method of transport*
- Own car
- Public transport
- Other
Please specify*
Are you registered with a Jobactive provider?*
- Yes
- No
Who is your Jobactive provider?*
Do you have a disability or health issue that may restrict the type of work you can do?*
- Yes
- No
Please specify any restrictions to work*
What is your highest level of education*
- High School
- Certificate I, II, III, IV
- Diploma
- University
Year level completed*
Qualification/s completed*
How did you hear about our services?*
- Internet
- Facebook
- Newspaper/TV
- Family/Friend
- TAFE Staff
- Referred from another organisation
- Other
Organisation referred from*
Please specify*

CAREER INFORMATION
Which best describes your current situation?*
- Unemployed
- Studying
- Employed
Length of unemployment*
What course are you currently studying?*
Are you employed*
- Full-time
- Part-time
- Casual
How many hours a week do you work on average?*
I am seeking*
- Career guidance
- To undertake training
- Employment
I am seeking*
- Career guidance
- Further training
- Employment
I am seeking*
- Career guidance
- To undertake training
- Change careers
- Greater employment
- To reduce my work hours
Desired training*
In your current job role?*
- Yes
- No
Current job role*
Desired industry/occupation (choose all that apply)*
- Accommodation & Food Services
- Administrative & Support Services
- Agriculture, Farming & Fishing
- Education & Training
- Electricity, Gas, Water & Waste Services
- Finance & Insurance Services
- Health Care & Social Assistance
- Information Media & Technology
- Manufacturing
- Mining
- Professional, Scientific & Technical Services
- Public Administration & Safety
- Rental, Hiring & Real Estate Services
- Retail Trade
- Transport, Postal & Warehousing
Career goals or any other relevant information*
Any other relevant information

REGISTRATION INFORMATION
Please indicate if you have the following (choose all that apply)
- Resume
- Cover Letter
- First Aid Certificate
- Working With Children Check
- White Card
- Police Clearance
- Drivers Licence
Licence Type*
Personal barriers or challenges (choose all that apply)
- Transport
- Childcare
- Disabilities
- Accommodation
- Financial
- Work Clothes
- Skills
- Confidence
- Other
Please specify*
Career Goals & Actions*

Please note the Jobs & Skills Centre may contact you to participate in an outcome survey
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Home Phone
- Mobile
- Email
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Home Phone
- Mobile
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Home Phone
- Email
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Mobile
- Email
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Home Phone
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Mobile
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
- Email
DECLARATION OF CONSENT*
- I give my consent to the Jobs & Skills Centre to discuss and share my information with relevant agencies and organisations to increase my opportunity to gain sustainable employment.
Location*

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